Provider Demographics
NPI:1699959189
Name:GARY A. SHOEMAKER, D.C. P.C.
Entity type:Organization
Organization Name:GARY A. SHOEMAKER, D.C. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-886-8030
Mailing Address - Street 1:18720 MACK AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2993
Mailing Address - Country:US
Mailing Address - Phone:313-886-8030
Mailing Address - Fax:313-886-4350
Practice Address - Street 1:18720 MACK AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-2993
Practice Address - Country:US
Practice Address - Phone:313-886-8030
Practice Address - Fax:313-886-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004518261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OH202790Medicare UPIN
0Q24574Medicare PIN